Child development

Question 1

Define child development

Answer 1

• Development is the global impression of a child which encompasses growth, increase in understanding, acquisition of new skills and more sophisticated responses and behaviour
• Serves to endow the child with increasingly complex skills in order to function in society

Question 2

What are the developmental domains?

Answer 2

1. Gross motor and posture
2. Fine motor and vision
3. Language and hearing
4. Social, emotional and behavioural

Question 3

What is abnormal development?

Answer 3

• Refers to slow acquisition of skills and follows 3 main patterns: 1. Slow but steady 2. Plateau 3. Regression - Delay may occur in 1 or more domain(s)

Question 4

What tools are available for assessing childhood development?

Answer 4

• Developmental screening
• Standardised developmental assessment - Schedule Of Growing Skills (II), Griffiths developmental scale

Question 5

What are the key developmental milestones at 6 weeks?

Answer 5

1. Gross motor: head level w/body in ventral suspension
2. Fine motor + vision: fixes and follows
3. COMMUNICATION/ HEARING: becomes still in response to sound
4. SOCIAL SKILLS (self help): Smiles

Question 6

What are the key developmental milestones at 3 months?

Answer 6

1. Gross motor: holds head at 90 degrees in ventral supension
2. Fine motor + vision: holds an object placed in hand
3. COMMUNICATION/ HEARING: turns to sound
4. SOCIAL SKILLS (self help): hand regard, laughs, squeals

Question 7

What are the key developmental milestones at 6 months?

Answer 7

1. Gross motor: no head lag on pull to sit; sits with support; in prone position lifts up on forearms
2. Fine motor + vision: palmar grasp of objects; transfers objects hand to hand
3. COMMUNICATION/ HEARING: vocalisations
4. SOCIAL SKILLS (self help): may finger feed self

Question 8

What are the key developmental milestones at 9 months?

Answer 8

1. Gross motor: crawls; sits steadily when unsupported + pivots around
2. Fine motor + vision: pincer grasp; index finger approach’ bangs 2 cubes together
3. COMMUNICATION/ HEARING: 2 syllable babble, non-specific - consonant-vowel, e.g. mama
4. SOCIAL SKILLS (self help): waves bye bye; plays pat-a-cake; indicates wants; stranger anxiety emerging

Question 9

What are the key developmental milestones at 12 months?

Answer 9

1. Gross motor: pulls to stand; cruises; may stand alone briefly; may walk alone
2. Fine motor + vision: puts block in cup; casts about
3. COMMUNICATION/ HEARING: 1-2 words; imitates adults’ sounds
4. SOCIAL SKILLS (self help): imitates activities; object permanence (objects exist when cannot be seen) established; stranger anxiety established; points to indicate wants

Question 10

What are the key developmental milestones at 18 months?

Answer 10

1. Gross motor: walks well; runs
2. Fine motor + vision: builds tower of 2-4 cubes’ hand preference emerges
3. COMMUNICATION/ HEARING: 6-12 words
4. SOCIAL SKILLS (self help): uses spoon; symbolic play - “talking” on phone; domestic mimicry - “helps” in household chores

Question 11

What are the key developmental milestones at 2 years?

Answer 11

1. Gross motor: kicks ball; climbs stairs 2 feet per step
2. Fine motor + vision: builds tower of 6-7 cubes; does circular scribbles
3. COMMUNICATION/ HEARING: joins 2-3 words; knows some body parts; identifies objects in pictures
4. SOCIAL SKILLS (self help): can remove some clothes

Question 12

What are the key developmental milestones at 3 years?

Answer 12

1. Gross motor: stands briefly on one foot; climbs stairs 1 foot per step
2. Fine motor + vision: builds tower of 9 cubes; copies a circle
3. COMMUNICATION/ HEARING: talks in short sentences that a stranger can understand
4. SOCIAL SKILLS (self help): eats with fork + spoon; puts on clothes; may be toilet trained

Question 13

What is a cause of developmental milestone regression?

Answer 13

Autism

Question 14

What are some patterns of abnormal development?

Answer 14

1. Slow but steady
2. Plateau
3. Regression

Common presenting problems

• Delayed walker
• Clumsy child
• Delayed speech and language
• Odd social interaction- ASD/Aspergers
• Hyperactivity

Question 15

How are children with abnormal development evaluated?

Answer 15

History

1. Antenatal - illnesses/infections; medications; drugs; environmental exposures, pregnancy supplements
2. Birth –prematurity, prolonged/complicated labour
3. Postnatal - illnesses/infections; trauma
4. Consanguinity – increases chances of chromosomal or autosomal recessive conditions

PMHX

1. Developmental milestones (history) from parent
2. Current skills - Developmental assessment + general and neurological examination
3. Investigations
4. Parental anxiety
5. Family history

Focussed physical examination

• Look of child
• Gorwth
• OFC
• Hearing and Vision
• Skin
• Genitalia

Bloods and imaging

• FBC and ferritin
• TSH
• Chromosomes
• Lead
• US
• CT/MRI

Question 16

What are the types of developmental delay?

Answer 16

Question 17

What are the causes of global, motor and language delay respectively?

Answer 17

Causes of global delay

• Chromosomal abnormalities e.g. Down’s syndrome, Fragile X
• Metabolic e.g. hypothyroidism, inborn errors of metabolism
• Antenatal and perinatal factors
  
  • Infections, drugs, toxins, anoxia, trauma, folate def
• Environmental-social issues
• Chronic illness

Causes of motor delay

• Cerebral palsy
• Global delay eg Down’s syndrome
• Congenital dislocation hip
• Social deprivation
• Muscular dystrophy-Duchenne’s
• Neural tube defects: spina bifida
• Hydrocephalus

Causes of language delay

• Hearing loss
• Learning disability
• Autistic spectrum disorder
• Lack of stimulation
• Impaired comprehension of language
  
  • Developmental dysphasia
• Impaired speech production
  
  • stammer, dysarthria

Question 18

Summarise the examples of developmental delay

Answer 18

1. Cerebral palsy - disorder of mvmt and posture
   
   • 4 different types = spastic, athetoid, ataxic and mixed type
2. Autism spectrum disorder
3. ADHD
4. Learning disability - reduced intellectual functioning, delay in early milestones, dysmorphic features
5. Other common behaviours –sleep onset/freq night waking, eating, Toileting

Question 19

What is happening to the incidence of autism + ADHD?

Answer 19

Increasing incidence

Question 20

What are the characteristics of autism?

Answer 20

• Prevalence = 3-6 per 1000 live births - Boys>girls - Usually presents between 2-4yrs
• Features:
  
  1. Impaired social interaction
  2. Speech and language disorder
  3. Imposition of routines with ritualistic and repetitive behaviour
• Comorbidities include learning and attention difficulties, and epilepsy
• Managed by intensive support for child + family

Question 21

What are the diagnostic criteria for ADHD?

Answer 21

1. Inattention
2. Hyperactivity
3. Impulsivity
4. Lasting > 6 months
5. commencing < 7 years and inconsistent with the child’s developmental level

• These features should be present in more than one setting, and cause significant social or school impairment
• Management Psychotherapy - Behavioural therapies Family therapy

Question 22

How is a child with developmental delay managed clinically?

Answer 22

1. Investigations - Depends on suspected cause - E.g. cytogenetic studies - Metabolic screen (thyroid, renal, liver and bone profiles) - Blood ammonia and lactate - Urine and blood organic and amino acids - Creatine kinase - Imaging – CT, MRI; EEG - Nerve and muscle biopsy 2. Other professionals - Referral to members of MDT helps identify problems and target input.

Question 23

How is a child with developmental delay examined?

Answer 23

1. Growth parameters – height, weight, head circumference 2. Dysmorphic features 3. Neurological examination and skin 4. Systems examination to identify associations, syndromes 5. Standardised developmental assessment – SOGSII, Griffiths

Question 24

What do children with ADHD have an increased risk of?

Answer 24

1. Conduct disorder
2. Anxiety disorder
3. Aggression
4. A significant proportion of children with ADHD will become adults with antisocial personality and there is an increased incidence of criminal behaviour and substance abuse.

Question 25

What are the risk factors for ADHD?

Answer 25

1. Boys \> girls, 4:1 2. Learning difficulties and developmental delay - Neurological disorder, e.g. epilepsy, cerebral palsy 3. First-degree relative with ADHD 4. Family member with depression, learning disability, antisocial personality or substance abuse

Question 26

How is ADHD managed?

Answer 26

1. Psychotherapy - behavioural therapies 2. Family therapy 3. Drugs - if therapy is insufficient - stimulants 4. Diet e.g. excluding red food colouring

Question 27

What problems do children with ADHD face later in life?

Answer 27

1. Antisocial personality 2. Increased incidence of criminal behaviour + substance abuse